EGDT, it had such PROMISE

The NEJM this week is overflowing with papers relevant to critical care. Amongst them is the anticipated PROMISE trial, the final chapter in the EGDT trilogy, following on from PROCESS and ARISE.
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For those of you blissfully unaware of the PROMISE trial, this was a pragmatic randomised trial across  56 hospitals in England. Patients were randomly assigned to receive either early goal-directed therapy (EGDT; a 6-hour resuscitation protocol) or usual care. The primary clinical outcome was all-cause mortality at 90 days.

This study enrolled 1260 patients (630 in each arm), powered to detect a 20% difference in mortality. This was similar between groups: 184 of 623 patients (29.5%) in the EGDT group and 181 of 620 patients (29.2%).

The conclusions are that EGDT does not add extra benefit in addition to the current standard of care.

In patients with septic shock who were identified early and received intravenous antibiotics and adequate fluid resuscitation, hemodynamic management according to a strict EGDT protocol did not lead to an improvement in outcome.

This continues to reflect the improvements in standard care that have evolved since the initial Rivers study and the Surviving Sepsis campaign.

What are people saying?

The publication of an article like this generates a lot of discussion in the FOAM world. Some of the reviews already available for this article are:

 

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